24- mentoring the younguns

This afternoon I was at the grocery store. My cashier was a young bubbly sort who waxed rhapsodically over the brown sugar I was buying. I told them I baked cookies weekly for the operating room department that I worked for. Therefore, I need a LOT of brown sugar.

They were equally enthusiastic about the operating room. They thought that must be so cool.

I assured them that it was. And being an operating room nurse was amazing.

Even if, or because of, all the patients are under anesthesia.

They confessed that they were looking at nursing as a career.

You know, after they graduated from high school. In 2 years.

The thing about being a nurse is that we always feel the need to give back, to give advice on nursing as a possible career. Or to offer encouragement when it is needed.

They asked about my schooling, and how long it took to become a nurse.

I said that was a complicated question.

My ADN took about 2 years. Plus six months on prerequisites.

My BSN took about 18 months.

My MSN took about 2 years.

And my PhD, well, I was in the third year of the program.

They looked astonished by this outpouring of information. And a bit intimidated.

Reining it back, I encouraged them to give serious consideration to becoming a nurse. And the best way to start is with an ADN degree. And that not all nurses did all the other schooling.

The ADN is the foot in the door. Whatever they did after that was icing on their cake.

They said they had always wanted to work with kids. I smiled and said that kids need surgery too.

They grinned and told me to have a good rest of my day and that they would think about what I said.

I didn’t want to tell them that my nursing license was old enough to drink.

Cookie Thursday 10/10/24- I’ve got my eye on you chocolate cookie

I have broken one of my hard and fast rules for Cookie Thursday is a Thing.

I have made a chocolate cookie.

I don’t enjoy making chocolate cookies. So I don’t.

However, since the theme of the month is This is Halloween, and the makes have chocolate in them and I had eyeball candies, I decided to make an exception.

Because those white eyes need to pop!

I made chocolate cookie dough and added the eyeballs, which I have to point out I have used before in other baked goods. Drop them onto the baking sheets and bake 10 minutes. Easy peasy.

Except, this time, for some unknown reason, the eyeballs melted!

I thought this was going to be a cute cookie, with the contrast between chocolate cookie and white eyeballs. But no.

What I am left with is a chocolate cookie with random toffee bits, instead of candy eyeballs.

Rude.

However, par for the course because the base of Cookie Thursday is a Thing has been experimentation. This is one experiment that I will not do again.

The cookies are fudgy and crisp and chewy and I wouldn’t kick them out of the cookie jar. But not what I had in mind.

Best Kept Secrets of the OR #9- It’s okay to argue with the anesthesiologist

In my first nursing school, straight out of high school, soaking wet behind the ears, doctors still had a mystique about them. This was definitely true in the Midwest, where I went to nursing school.

These weren’t the days of standing when the doctor entered the room, of giving up your seat or your pen when required.

However, the doctor, usually a man, commanded respect, just by the virtue of their degree.

Well, over 30 years later I know better.

Doctors are just human. Sometimes they make iffy decisions with the aim of getting off the floor sooner. Sometimes they are good allies against surgeons who want to cut to cut, not to save a life.

It is absolutely okay to push back on them.

Just like it is absolutely okay to push back on the surgeon, or the charge nurse, or the CRNA.

This is part and parcel of protecting the patient.

After all, as the circulator, you are the wall between the patient’s well-being and the rest of the team.

But, be a wall that has some flexibility in it. And don’t be afraid to call them on their bullshit.

They won’t like it in the short term, and you might get written up, but you will know that you did the best for the patient that you could in the moment.

For example, there was a critically ill patient that we worked on in the middle of the night years ago. This patient was in bad shape, tanking blood pressure, holding on to their carbon dioxide, and getting more delusional with it, sky-high heart and breathing rate. The kind of patient you just know, in the pit of your stomach, is circling the drain. Urosepsis in a big, bad way. The anesthesiologist was so focused on getting the numbers that they wanted for the pre-op they were standing in the way of actually helping the patient. I told them that the only way to start helping this patient was to let the urologist put a stent up the ureter and if we delayed any longer for a BS reason, they might not survive that. The anesthesiologist, taken aback, stared at me for a moment. After all, who was I to demand that they treat the patient, no matter the number. They opened their mouth to yell at me and glanced at the patient, who was deteriorating by the minute. Swallowing whatever vile thing they were about to spew they gestured to the CRNA and asked what was taking so long.

Eye roll here.

But confronting them at that moment was the correct course of action. It allowed us to get the patient to the room that much faster, to go to sleep that much more smoothly, and to get the stent placed that much quicker. We did take the patient directly to ICU, still intubated, after the 10-minute case. The patient was exhausted and would probably get sicker before they got better. Two days later, I was dropping another patient off in the ICU and I saw the uroseptic patient and their family in a room. They were looking so much better that they didn’t even look like the same person, who had been gray-faced, panting, and moaning in pain and delirium 58 hours before. When I stopped in the room, of course, they didn’t recognize me, but the spouse did.

This is an example when speaking sharply to the anesthesiologist was worth it. The shock of me being a patient advocate and telling them that the only way to cure the patient was to stop dicking around chasing the perfect number really worked in the patient’s favor.

Don’t be afraid to call an anesthesiologist an ass, or a surgeon for that matter. My job was the safe, TIMELY procedure for the patient.

And I stand by it.

Tuesday Top of Mind 10/8/24- explicative deleted the supreme court

Me again.

Back on abortion news that is so hot it would burn if I had any fingertips left.

Yesterday, the supreme court declined to hear a case from the BIDEN administration about the draconian abortion law in Texas. The state was using that law to say, nah bro, even if a patient is on the verge of dying, emergency rooms don’t have to do an abortion. And they send the woman HOME.

In other words, in starker words, let the woman die instead of performing an abortion, which is the evidence-based standard of care for miscarriage. The problem is that the fetus isn’t dead YET, or at least their cardiac poles are working, and the woman isn’t sick enough YET.

Let the woman die.

Because the output of her uterus has a stronger case in front of the current supreme court than her right to life.

You know, the right to life is in the constitution’s preamble.

But, sure, why not deny a woman her rights?

After all, she is a lesser being than the clump of cells in her uterus.

They had punted a similar EMTALA case in June of this year. Do you remember?

EMTALA is a federal law that means everyone who presents to the emergency room gets the treatment they need. No matter what it is.

Ringing a bell now?

The thing is the Biden administration was asking to send the fifth circuit appeals court ruling on EMTALA and Texas back to a lower court to be retried.

The supreme court said nah.

I am not sure who is paying attention if anyone. There are a lot of other things commanding our attention: the 2024 general election, the devastating loss of life and property over 6 states after Hurricane Helene, the category 5 Hurricane Milton that is bearing down on almost the exact spot where Hurrican Helene hit Florida, the Russian bots that are trolling the news sites and giving out lies. I won’t even talk about their most current lie about FEMA money but it is certainly a lie.

Misdirection is the standard for all magic tricks.

I wonder what else they are doing when we aren’t paying attention.

To be clear, the they isn’t just the supreme court, but news media, and the aforementioned troll bots that are desperate to make you believe lies.

I am tired of being told that my life doesn’t matter, that what I want doesn’t matter by these clowns.

I am definitely tired of being reminded over and over and over and over and over again that because I am a woman my life, liberty, and pursuit of happiness matter less than the potential output of my uterus.

Don’t get me started on the fact that my husband and I do not have children. Which also makes us lesser.

Post-it Sunday 10/6/24- No is a complete sentence

The gown card reads “No is a complete sentence.”

It is human nature to explain why you are saying no.

Stop.

You don’t owe anyone an answer. Because no is a complete sentence.

There are situations when it isn’t appropriate. Like at work. In the middle of an operation, I would never tell a doctor no to a reasonable request. I have told a doctor no when the OR board was busting and each room was running full out with no end in sight and they asked for another room. I laughed and said no.

This is your work life. No is sometimes still appropriate. Yes, but is also appropriate.

However, I am talking to the outside of work you. It is okay to utilize the two-letter answer.

When you are uncomfortable.

When you want to go home and read with a cat on your lap.

When you don’t want to do the requested thing.

When the requested thing doesn’t work in your schedule, your life, your peace.

After all, around the age of 2 toddlers start to learn to assert their independence by saying no. A lot. A lot, a lot.

We can learn a lot from toddlers. Just like they are learning from us.

But naps, naps are awesome.

Remember that no is a complete sentence and you are, most likely, an adult and you can say no.

Let’s practice.

Do you want to work extra tonight? (insert sob story here)

You don’t really want to work extra as you have plans with your significant other/best friend/cat.

It is okay to say no here.

With no explanation.

No is a complete sentence.

School Me Saturday 10/5/24- Stop believing everything someone sees on the internet!

This post is not going to be about school. Or classes. Or going to classes. Or getting ready to go on fall break. Or tests or assignments.

No, this post is going to be about me shouting STOP BELIEVING EVERYTHING SOMEONE OR YOU SEES ON THE INTERNET!!!

For fucks’ sake, stop it.

There is a continuing natural disaster that is happening right here in our state. Hurricane Helene put a serious beat down on Western North Carolina. The death toll keeps rising, people have lost their houses, their friends, their pets, and their livelihoods. Not to mention to lack of electricity, water, and cell service. With no end in sight.

So why do I see so many people spreading the false report that North Carolina has a shortage of body bags? Or that FEMA, who has affected 6 states to cover, hasn’t been on the ground yet?

Did we learn nothing from the natural disaster we just spent the last 5 years living through and are still going through?

Or did we learn the wrong lesson from covid?

The lesson is that some people will believe what they see on the internet. They take it as gospel truth, not the lies that others are spreading. You know, just like with the vaccines.

Enough with the doom scrolling. Especially if you believe everything the internet tells you.

Know that there are assholes out there who will be trying to prey on the vulnerable. They go door to door and lie that they are from the county or even FEMA when they are decidedly not.

Don’t worry, there is a special place in hell that they undoubtedly believe in for them.

The best pieces of advice that I can give you as a nascent researcher-

Don’t believe everything you read or watch on the internet.
Don’t listen to someone who tells you something outrageous with no facts to back it up.
If you do find it believable, find an alternate source of the same facts. To have confirmation from an alternate, reputable source is best.
Stop the doom scrolling.
If you still think that something nefarious is going on, get involved. Donate time or supplies to those who are suffering in Western North Carolina. Make sandwiches for One World Kitchen, or give blood. Do something besides perpetuating the lies that someone else is peddling to make a buck.
Be wary of those who are trying to make a buck off of someone else’s suffering.
Don’t believe everything you read or watch on the internet. And don’t listen to someone who tells you something outrageous with no facts to back it up. It bears repeating.

Have an open mind but do not be swept up in the lies that are around on the internet.

Have an open heart to help those whose entire lives are irrevocably changed and challenged by Hurricane Helene. Donate your time or some goods to aid in the recovery.

Because what if you lived in Western North Carolina, wouldn’t you want someone to help and not hinder you with lies?

I would.

Cookie Thursday 10/3/24- This is Halloween Week 1

This is Cookie Thursday is a Thing and the theme of the month is This is Halloween.

This is a song from Nightmare Before Christmas.

Works great as a theme too.

This week’s spooky make is a candy corn cookie.

Love them or hate them, candy corn is emblematic of Halloween.

Did you know that if you put candy corn instead of chocolate chips into a cookie base and bake it, the candy corn melts and becomes a wonderful caramel addition to the cookie?

The resulting melting candy corn is chewy and delightful.

I usually make it every year for October Cookie Thursday is a Thing.

And apparently I will be making cookies for Cookie Thursday is a Thing This is Halloween with candy inside the cookies.

What will I make next week?

I am sure it will be goulishly delicious.

Best Kept Secrets of the OR #8- Phenomenal technological know-how…itty bitty email manners

“Phenomenal cosmic powers…itty bitty living space.”

This is a quote from Genie in the 1992 Disney movie Aladdin. He is speaking to Aladdin about the genie gig. And that he has immense powers, but the trade-off is that his living space in the lamp is small.

The OR staff have a trade-off as well. We are very comfortable with the ever-changing technology and ever-changing rules of that technology. 99% of the OR staff that I personally know is technologically savvy.

And we do it well.

Despite the surgeon’s grumbling about wanting to move faster.

The big but is that people don’t know how to respond to a group email.

Some people reply all. This means that whatever they meant to send to the original sender was sent to EVERYONE on the group email. So many times I’ve been privy to information I should not have and I do not want.

Or how to respond without shouting. In email parlance, all CAPS is shouting. BECAUSE THIS LOOKS AGGRESSIVE. If you are not trying to be emphatic, cool it with the caps lock.

Another bad email etiquette is using slang. This means not using slang at all. You may know or think that Dog is an address of respect but the person you are writing may not and they feel insulted.

Keep email language clear and concise. Be polite when addressing your recipient. Don’t be formal when writing an email. Always use an informative subject line if you are the original writer.

But the biggest is don’t reply to all unless your message is for the group.

By the way, all of these unwritten rules of email etiquette apply to webinar chats

I write that because in the last webinar, I did, about DEI, someone shouted in the chat that WE SHOULD HAVE MORE MEN IN NURSING. WHY DON’T WE HAVE MORE MEN IN NURSING. It is a little offputting and I now understand why that is a rule.

Stop shouting!

Tuesday Top of Mind 10/1/24- Blame the victim… of course

They are weaponizing abortion bans against victims. Blame the victim is the name of their game and it has never been clearer. In their minds and out of their mouths comes language that says that if a woman hadn’t had sex and sought a medication abortion and had a rare complication and sought care from the state in which they live and was denied actual medical care for a true medical emergency and they shun her and turn her away from the emergency room and she dies it is her fault.

Did you get all that?

It is like holding someone’s arm and using your muscles to slap their face, telling them all the while “Stop hitting yourself”. In no way are they hitting themselves. You are. And blaming them for it.

Because she wasn’t a “good girl” and had sex.

After all, the vagina is the root of all evils. Right?

Twas Eve who ate the apple from the Tree of Knowledge in the Garden of Eden.

Twas Eve who tempted Adam to eat the apple.

Twas Eve who got them banished from the Garden of Eden.

Because blame the woman, right?

Some people believe that their holy book forbids abortion. Without actually coming out and saying it. Because abortion is not mentioned in the Bible. Neither the old testament nor the new testament. Not in the Jewish version.

Same thing for birth control. Nowhere is it mentioned that it is banned.

But some people believe it because their god said so. No, no, they say when you point this out. But I know that it is something that he doesn’t want. No, no, not his son when you point this out that their behavior isn’t exactly Christ-like. Not his son. I just don’t want god to be mad at me for a reason I made up in my head.

Do you know what is also not banned? In-vitro Fertilization.

I don’t normally write about essentially the same thing for Tuesday Top of Mind two weeks in a row.

But they need to get over themselves.

Because they are killing women and the potential children they profess to want born. Without any medical support or financial support or legislative support.

No, they want fully-aged people who can work and pay taxes. Because infants and children are messy and demanding. And they don’t have the patience. But they want the money.

And the control.

but mostly the money.

Post-it Sunday 9/29/24- the in crowd

The gown card reads “Drs are a collegial bunch. As if having an MD gets you into a special club.”

My sister is a doctor. A pathologist, in fact. I know all about the years of schooling, the internship year, and the resident years, and the fellowship years (if they do that).

I get it.

I also understand why there is a special handshake doctor club.

I get it.

No one else can possibly understand but another doctor.

However, there is also a hierarchy among doctors. The general surgeons generally look down on the ob-gyns, the orthopedists look down on the podiatrists, and the neurologists and cardiothoracic surgeons look down on everyone.

Bullying between doctor groups is not okay.

It smacks of high school. And all the doctors I know have at least 10 years of post-high school education.

There is also a rivalry between the PhD nurse and the DNP (doctor of nursing practice), for no good reason. The PhD nurse does the research, and the DNP puts it into practice.

Stop acting like a bunch of teenagers!

Did you not learn in high school that bullying and snobbish behavior are not how to treat a colleague?

I was gonna write act your wage, but I don’t think so.

Definitely act your age.

Bullying is not on.

*** As an aside, reading the rest of the notes on the card I wonder if this was not a note about healthcare. The rest of the gown card is about a serial killer mystery I plotted out. And the main characters. The age of the gown card definitely bears this out. But the message is still the same, fictional doctors or non-fictional doctors need to stop acting like a bunch of teenagers and act your age.